Article Detail - JA DME

A Prior Authorization Request (PAR) is required for all replacement power mobility devices (PMDs) on the Required Prior Authorization List. PMDs replaced within the five-year reasonable useful lifetime (RUL) due to lost, stolen, or irreparably damaged items should be submitted as an expedited review. Expedited reviews must be indicated either on the coversheet, or on the Noridian Medicare Portal (NMP) and are completed by the DME MAC within two business days. When an expedited review is requested, documentation must support the reason for the expedited review. Reminder: Append the RA modifier to replacement PMD claims. Claims will be denied if the RA modifier is billed but a PAR for replacement was not received and affirmed.